Journal of Medical Imaging and Radiation Oncology最新文献_第9页

Radiotherapy protocol compliance in routine clinical practice for patients with stages I–III non-small-cell lung cancer I-III 期非小细胞肺癌患者常规临床实践中放疗方案的合规性。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-30 DOI: 10.1111/1754-9485.13727

Xiaoshui Huang, Matthew Field, Shalini Vinod, Helen Ball, Vikneswary Batumalai, Paul Keall, Lois Holloway

Introduction

Despite the availability of radiotherapy treatment protocols for lung cancer, considerable treatment variation occurs in clinical practice. This study assessed compliance with a radiotherapy protocol for the treatment of patients with stages I–III non-small-cell lung cancer (NSCLC) in routine clinical practice and to identify factors that were associated with compliance.

Methods

The Cancer Institute New South Wales eviQ treatment protocol for external beam radiotherapy of stages I–III NSCLC was taken as the reference to measure compliance. All inoperable patients with stages I–III NSCLC and documented ECOG performance status treated with radiotherapy between 2007 and 2019 at two radiotherapy facilities were available for analysis. Protocol compliance rates were calculated. Univariate and multivariate logistic regression models with 23 input factors were used to determine factors significantly associated with compliance. Survival analysis was conducted for both compliant and non-compliant treatments.

Results

Overall, 656 patients met the inclusion criteria. Protocol compliance was 16%. Alternative dose/fractionation was responsible for 49% of non-compliant treatments with 30% receiving an alternative curative fractionation. Five of 23 factors (age at the start of radiotherapy, stage group, ECOG performance status, tumour location and alcoholism history) showed significant associations with protocol compliance on multivariate analysis. There was no significant difference in median survival between patients receiving protocol compliant treatment (15.1 months) and non-compliant treatment (15.6 months).

Conclusion

Adherence to the eviQ curative radiotherapy protocol for stages I–III NSCLC was low. Alternative dose/fractionation schemes were the main reason for non-compliance. Protocol compliance was not associated with outcome.

介绍：尽管目前已有肺癌放射治疗方案，但在临床实践中仍存在相当大的治疗差异。本研究评估了常规临床实践中I-III期非小细胞肺癌（NSCLC）患者对放射治疗方案的依从性，并找出与依从性相关的因素：方法：以新南威尔士癌症研究所制定的 I-III 期非小细胞肺癌体外射束放疗 eviQ 治疗方案为参照，衡量依从性。2007年至2019年期间，在两家放射治疗机构接受放射治疗的所有无法手术的I-III期NSCLC患者，以及记录在案的ECOG表现状态，均可用于分析。计算了协议符合率。使用包含 23 个输入因素的单变量和多变量逻辑回归模型来确定与依从性显著相关的因素。对依从和不依从治疗进行了生存分析：共有 656 名患者符合纳入标准。协议符合率为 16%。49%的不合规治疗患者接受了替代剂量/分次治疗，其中30%接受了替代治疗分次治疗。多变量分析显示，23个因素中有5个（开始放疗时的年龄、分期组别、ECOG表现状态、肿瘤位置和酗酒史）与方案依从性有显著关联。接受符合方案治疗（15.1个月）和不符合方案治疗（15.6个月）的患者的中位生存期没有明显差异：结论：I-III期NSCLC患者对eviQ根治性放疗方案的依从性较低。其他剂量/分次方案是不遵守方案的主要原因。方案依从性与疗效无关。

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引用次数: 0

Is ultrasound sufficient in detecting adenomyosis as pre-procedure work-up for uterine artery embolisation? An audit in the community setting 作为子宫动脉栓塞术的术前检查，超声波是否足以检测子宫腺肌症？在社区环境中进行审计。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-29 DOI: 10.1111/1754-9485.13739

Eisen Liang, Razeen Parvez, Sylvia Ng, Bevan Brown

引用次数: 0

Association of radiation-induced epilation and interventional neuroradiology procedures 辐射引起的脱毛与介入神经放射学手术的关联。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-26 DOI: 10.1111/1754-9485.13730

Deborah Carrick, Vinicius Carraro do Nascimento, Laetitia de Villiers, Henry Rice

Introduction

The aim of this study is to quantify the association of temporary epilation following interventional neuroradiology (INR) procedures and compare the peak skin dose (D_skin,max) threshold to published values.

Methods

Gold Coast University Hospital (GCUH) is a major centre for INR with over 500 primarily interventional procedures performed every year. D_skin,max is calculated when the reference air kerma (K_a,r) exceeds 3 Gy. If the D_skin,max exceeds 3 Gy, the patient is followed up for any skin effects. An audit was undertaken of these results over a 2-year period.

Results

From January 2020 to December 2021, 140 patients who underwent INR procedures had a K_a,r > 3 Gy, 66 resulted in a calculated D_skin,max >3 Gy, and 45 were successfully followed up. Twenty patients (44%) reported no skin effects and 25 (56%) reported skin effects, which were almost exclusively epilation. The mean (range) D_skin,max for patients with no reported skin effects and those with observed skin effects was 4.6 Gy (3.0–11.1 Gy) and 4.2 Gy (3.0–7.0 Gy), respectively.

Conclusion

These results demonstrate that temporary epilation was observed in 56% of patients, in a cohort of 45 patients who underwent an INR procedure with calculated D_skin,max >3 Gy and successful follow-up. The results support evidence in the literature that suggests the approximate threshold for temporary epilation reported by the International Commission on Radiological Protection (ICRP) may be too high for incidence of this effect, specifically on the scalp, when D_skin,max is calculated from K_a,r (using commonly used corrections and assumptions in the calculation).

简介：本研究旨在量化介入神经放射学（INR）手术后临时脱毛的相关性，并比较皮肤峰值剂量（Dskin,max）阈值：本研究旨在量化介入神经放射学（INR）手术后临时脱毛的相关性，并将峰值皮肤剂量（Dskin,max）阈值与已公布的数值进行比较：黄金海岸大学医院（GCUH）是主要的介入神经放射中心，每年主要进行 500 多例介入手术。当参考空气切尔马（Ka,r）超过 3 Gy 时，就会计算出 Dskin,max 值。如果 Dskin,max 超过 3 Gy，就会对患者的皮肤影响进行跟踪。对这些结果进行了为期两年的审计：2020年1月至2021年12月，140名接受INR手术的患者的Ka,r>3 Gy，66名患者的计算Dskin,max>3 Gy，45名患者成功接受了随访。20名患者（44%）报告没有皮肤效应，25名患者（56%）报告有皮肤效应，几乎全部是脱毛。未报告皮肤效应的患者和观察到皮肤效应的患者的 Dskin,max 平均值（范围）分别为 4.6 Gy（3.0-11.1 Gy）和 4.2 Gy（3.0-7.0 Gy）：这些结果表明，在接受 INR 手术的 45 名患者中，有 56% 的患者观察到了暂时性脱毛，计算出的 Dskin,max >3 Gy，并进行了成功的随访。这些结果支持了文献中的证据，即国际放射防护委员会（ICRP）报告的暂时性脱毛的近似阈值可能过高，无法从 Ka,r 计算出 Dskin,max （在计算中使用常用的校正和假设），特别是对头皮而言。

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引用次数: 0

Long-term clinical outcomes of male breast cancer patients treated with curative intent by trimodality therapy at an academic university hospital in India 印度一所大学附属医院采用三联疗法治愈男性乳腺癌患者的长期临床疗效。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-21 DOI: 10.1111/1754-9485.13733

Deep Chakrabarti, Arunima Ghosh, Sumaira Qayoom, Shreyamsa Manjunath, Bushra Khalid, Shiv Rajan, Naseem Akhtar, Pooja Ramakant, Mranalini Verma, Kirti Srivastava, Vijay Kumar, Rajeev Gupta, Anand Kumar Mishra, Madan Lal Brahma Bhatt

Introduction

Male breast cancer is rare and accounts for less than 1% of all breast cancer cases worldwide.

Methods

This retrospective cohort study included all patients of invasive male breast cancer treated with curative intent by a trimodality approach via a multidisciplinary team at an academic university hospital in India between 2009 and 2023. Records were identified from a prospectively maintained database. Clinicopathological parameters, treatment details and survival were recorded and analysed.

Results

Thirty-four patients were included. The median (IQR) age was 55(44–63) years. Most patients were overall stage III (74%) and node positive (79%) with Scarff-Bloom-Richardson grade II (50%). Twenty-five patients (73%) were oestrogen receptor (ER) positive. Lymphovascular space invasion (LVSI) and perineural invasion (PNI) were present in 62% and 21% of patients, respectively. The most common chemotherapy timing was adjuvant (53%) followed by neoadjuvant (41%), and the most commonly used regimen consisted of a combination of doxorubicin-cyclophosphamide followed by a taxane (53%). Most (85%) patients underwent a mastectomy, five patients underwent breast conservation. All patients received radiotherapy to a dose of 42.6 Gy in 16 fractions, followed by a tumour bed boost for those undergoing breast conservation. At a median follow-up of 70 months (range 10–159 months), the five and ten-year overall survival was 91% and 58%, and the five-year disease-free survival (DFS) was 67%. The median DFS was 72 months. On univariate analysis, the tumour sub-type (Luminal versus TNBC) significantly predicted DFS (P = 0.03 log-rank).

Conclusion

Breast cancer in males has a high incidence of node positivity, ER positivity and LVSI. Even with advanced stages at presentation, trimodality therapy in a multidisciplinary setting offers good long-term outcomes.

简介：男性乳腺癌是一种罕见病，在全球乳腺癌病例中占比不到 1%：男性乳腺癌非常罕见，在全球所有乳腺癌病例中占比不到1%：这项回顾性队列研究纳入了 2009 年至 2023 年间印度一所大学附属医院的多学科团队通过三联疗法治愈的所有浸润性男性乳腺癌患者。研究人员从前瞻性维护的数据库中找到了相关记录。记录并分析了临床病理参数、治疗细节和存活率：结果：共纳入 34 名患者。中位（IQR）年龄为 55（44-63）岁。大多数患者总体分期为 III 期（74%），结节阳性（79%），Scarff-Bloom-Richardson 分级为 II 级（50%）。25名患者（73%）雌激素受体（ER）阳性。分别有62%和21%的患者存在淋巴管间隙侵犯（LVSI）和神经周围侵犯（PNI）。最常见的化疗时机是辅助化疗（53%），其次是新辅助化疗（41%），最常用的化疗方案是多柔比星-环磷酰胺联合化疗，其次是紫杉类药物（53%）。大多数患者（85%）接受了乳房切除术，5名患者接受了保乳手术。所有患者都接受了剂量为42.6 Gy、分16次进行的放疗，接受保留乳房治疗的患者还接受了肿瘤床增强治疗。中位随访时间为70个月（10-159个月），五年和十年总生存率分别为91%和58%，五年无病生存率（DFS）为67%。中位无病生存期为 72 个月。单变量分析显示，肿瘤亚型（Luminal与TNBC）可显著预测DFS（P = 0.03 log-rank）：结论：男性乳腺癌的结节阳性、ER阳性和LVSI发生率较高。结论：男性乳腺癌的结节阳性、ER 阳性和 LVSI 的发生率较高，即使是晚期乳腺癌，多学科的三联疗法也能提供良好的长期疗效。

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引用次数: 0

Quality assurance and other challenges in paediatric radiotherapy: Accurate delivery of craniospinal radiotherapy. 儿科放射治疗的质量保证和其他挑战：准确实施颅骨放射治疗。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-15 DOI: 10.1111/1754-9485.13721

Alison L Salkeld, Jonathan Sykes, John Fernandez, Laura Murphy, Jennifer Chard, David I Thwaites

Introduction: Cranio-spinal radiotherapy (CSI) is used to treat central nervous system malignancies in paediatric, adolescent/young adult (AYA), and adult patients. Its delivery in the paediatric/AYA population is particularly challenging across different age groups. This study aims to assess the setup variations and dosimetric impact of CSI in paediatric and AYA patients.

Methods: This retrospective analysis included, 10 paediatric and AYA patients (aged 4-25) who underwent volumetric modulated arc therapy (VMAT) CSI between 2016 and 2022. Patient characteristics, diagnoses, prescribed CSI doses, and fractionation details were assessed. CT simulation and treatment planning followed standard protocols with setup errors were quantified by comparing daily treatment setup images with the planned position. The study evaluated the dosimetric impact on target volumes and organs at risk (OARs).

Results: The setup errors were identified, ranging from 0.5 to 6.2 mm in different directions, especially in the cranio-caudal direction. Despite these variations, there was minimal impact observed on the coverage of clinical target volumes (CTV) and doses to OARs (<1% relative change).

Conclusion: Ensuring precise setup in paediatric and AYA patients undergoing CSI is essential to maintain adequate CTV coverage. Although occasional substantial setup variations occurred during treatment, they had a limited impact on CTV coverage and OAR doses when infrequent. Appropriate planning target volume (PTV) margins can effectively compensate for occasional shifts. However, systematic errors could compromise treatment quality if undetected. Regular off-line review of patient set-up trends is recommended.

简介：颅脊放疗（CSI）用于治疗儿科、青少年/年轻成人（AYA）和成人患者的中枢神经系统恶性肿瘤。在儿科/AYA人群中，不同年龄段的放疗尤其具有挑战性。本研究旨在评估 CSI 在儿科和青壮年患者中的设置变化和剂量影响：这项回顾性分析包括 2016 年至 2022 年期间接受容积调制弧治疗（VMAT）CSI 的 10 名儿科和青壮年患者（4-25 岁）。对患者特征、诊断、CSI处方剂量和分层细节进行了评估。CT 模拟和治疗计划遵循标准协议，通过比较每日治疗设置图像和计划位置来量化设置误差。研究评估了剂量学对靶体积和危险器官（OAR）的影响：结果：确定了不同方向的设置误差，从 0.5 毫米到 6.2 毫米不等，尤其是在颅尾方向。尽管存在这些差异，但对临床目标容积（CTV）的覆盖范围和对危险器官（OAR）的剂量影响甚微：对接受 CSI 的儿童和青壮年患者而言，确保精确的设置对于保持足够的 CTV 覆盖率至关重要。虽然在治疗过程中偶尔会出现较大的设置变化，但这些变化对 CTV 覆盖率和 OAR 剂量的影响有限，因为这些变化并不常见。适当的规划目标容积（PTV）边缘可有效补偿偶尔出现的偏移。但是，如果系统误差未被发现，可能会影响治疗质量。建议定期对患者设置趋势进行离线审查。

{"title":"Quality assurance and other challenges in paediatric radiotherapy: Accurate delivery of craniospinal radiotherapy.","authors":"Alison L Salkeld, Jonathan Sykes, John Fernandez, Laura Murphy, Jennifer Chard, David I Thwaites","doi":"10.1111/1754-9485.13721","DOIUrl":"https://doi.org/10.1111/1754-9485.13721","url":null,"abstract":"<p><strong>Introduction: </strong>Cranio-spinal radiotherapy (CSI) is used to treat central nervous system malignancies in paediatric, adolescent/young adult (AYA), and adult patients. Its delivery in the paediatric/AYA population is particularly challenging across different age groups. This study aims to assess the setup variations and dosimetric impact of CSI in paediatric and AYA patients.</p><p><strong>Methods: </strong>This retrospective analysis included, 10 paediatric and AYA patients (aged 4-25) who underwent volumetric modulated arc therapy (VMAT) CSI between 2016 and 2022. Patient characteristics, diagnoses, prescribed CSI doses, and fractionation details were assessed. CT simulation and treatment planning followed standard protocols with setup errors were quantified by comparing daily treatment setup images with the planned position. The study evaluated the dosimetric impact on target volumes and organs at risk (OARs).</p><p><strong>Results: </strong>The setup errors were identified, ranging from 0.5 to 6.2 mm in different directions, especially in the cranio-caudal direction. Despite these variations, there was minimal impact observed on the coverage of clinical target volumes (CTV) and doses to OARs (<1% relative change).</p><p><strong>Conclusion: </strong>Ensuring precise setup in paediatric and AYA patients undergoing CSI is essential to maintain adequate CTV coverage. Although occasional substantial setup variations occurred during treatment, they had a limited impact on CTV coverage and OAR doses when infrequent. Appropriate planning target volume (PTV) margins can effectively compensate for occasional shifts. However, systematic errors could compromise treatment quality if undetected. Regular off-line review of patient set-up trends is recommended.</p>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A study comparing the cost-effectiveness of conventional and drug-eluting transarterial chemoembolisation (cTACE and DEB-TACE) for the treatment of hepatocellular carcinoma in an Australian public hospital 在澳大利亚一家公立医院进行的一项研究，比较了传统经动脉化疗栓塞术（cTACE）和药物洗脱经动脉化疗栓塞术（DEB-TACE）治疗肝细胞癌的成本效益。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-10 DOI: 10.1111/1754-9485.13731

Warren Clements, Abigail Chenoweth, Benjamin Phipps, Lowella Mozo, Mark Bolger, Laura Morphett, Tuan Phan, Jim Koukounaras, Matthew W Lukies

Introduction

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality and transarterial chemoembolisation (TACE) is an established technique to treat patients with intermediate-stage HCC. The aim of this study was to generate accurate costing data on cTACE and DEB-TACE in an Australian setting and assess whether one of the procedures offers favourable cost-effectiveness.

Methods

Costing study using data from all TACE procedures performed at a single centre between January 2018 and December 2022. Data were included from all direct and indirect costs including operative costs, wages, overheads, ward costs, transfusion, pathology, pharmacy and ward support. Cost-effectiveness was assessed by dividing local costs by existing high-quality data on quality-adjusted life years (QALYs).

Results

64 TACE treatments were performed on 44 patients. Mean age was 66.5 years and 91% were male. Overall median total cost per patient for the entire TACE treatment regime was AUD$7380 (range AUD$3719–$20,258). However, 39% of patients received more than one treatment, and the median cost per individual treatment was AUD$5270 (range AUD$3533–$15,818). The difference in median cost between cTACE (AUD$4978) and DEB-TACE (AUD$9202) was significant, P < 0.001. In calculating cost-effectiveness, each cTACE treatment cost AUD$2489 per QALY gained, while each DEB-TACE cost AUD$3834 per QALY gained. The incremental cost-effectiveness ratio (ICER) for DEB-TACE over cTACE was AUD$10,560 per QALY gained.

Conclusion

Both cTACE and DEB-TACE are low-cost treatments in Australia. However, DEB-TACE offers a solution with an ICER of AUD$10,560 per QALY gained which is below the Australian government willingness to pay threshold and thus is a more cost-effective treatment.

简介：肝细胞癌（HCC）是癌症相关死亡的主要原因，而经动脉化疗栓塞术（TACE）是治疗中晚期 HCC 患者的成熟技术。本研究旨在为澳大利亚的 cTACE 和 DEB-TACE 提供准确的成本计算数据，并评估其中一种治疗方法是否具有更高的成本效益：成本计算研究使用的数据来自 2018 年 1 月至 2022 年 12 月期间在一个中心进行的所有 TACE 手术。数据包括所有直接和间接成本，包括手术成本、工资、管理费用、病房成本、输血、病理、药房和病房支持。评估成本效益的方法是将当地成本除以现有的高质量质量调整生命年（QALYs）数据：44名患者接受了64次TACE治疗。平均年龄为 66.5 岁，91% 为男性。在整个 TACE 治疗过程中，每位患者的总费用中位数为 7380 澳元（范围在 3719 澳元至 20258 澳元之间）。不过，39% 的患者接受了一次以上的治疗，每次治疗的中位成本为 5270 澳元（范围在 3533 澳元至 15818 澳元之间）。cTACE（4978 澳元）和 DEB-TACE（9202 澳元）的中位成本差异显著，P 结论：在澳大利亚，cTACE 和 DEB-TACE 都是低成本治疗方法。然而，DEB-TACE 提供了一种解决方案，其每 QALY 收益的 ICER 为 10560 澳元，低于澳大利亚政府的支付意愿阈值，因此是一种更具成本效益的治疗方法。

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引用次数: 0

Medical imaging in melioidosis – 20-year experience in a non-endemic Australian city 类鼻疽的医学影像检查--澳大利亚一个非流行城市的 20 年经验。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-10 DOI: 10.1111/1754-9485.13729

Joel Earley MBBS, Richard Warne MBBS

Introduction

Melioidosis may occasionally be encountered in non-endemic areas and medical imaging is frequently used to identify and characterise sites of disease. The purpose of this study is to describe the spectrum of imaging findings encountered in melioidosis patients treated in the tertiary public hospitals of Perth, Western Australia, between 2002 and 2022.

Methods

A database search and electronic medical record review was used to identify cases. Cases were included if they had Burkholderia pseudomallei isolated on culture and if they had at least one diagnostic imaging study performed at a Perth public tertiary hospital. The relevant imaging studies were reviewed, and imaging findings were recorded.

Results

Thirty-six cases were identified. The most common disease manifestation was bacteraemia (72%, 26 cases), followed by pulmonary infection (58%, 21 cases), skin and soft tissue infection (22%, eight cases), prostate abscess (14%, five cases) and septic arthritis (6%, two cases). A previously unreported case of isolated melioid pleural effusion was identified, as was a case of reactivated chronic latent pulmonary melioidosis with an apparent delay of over 20 years between the onset of symptoms and the time of infection. In cases with pulmonary melioidosis, the major lung abnormalities on CT chest could be categorised into one of two distinct patterns: nodular-predominant (78%) or consolidation-predominant (22%).

Conclusion

Further research is required to assess the utility of the pattern-based categorisation of lung abnormalities on CT chest seen in the pulmonary melioidosis cases of this series.

导言：在非疫区偶尔也会遇到类鼻疽，医学影像常用于确定和描述发病部位。本研究旨在描述2002年至2022年期间在西澳大利亚州珀斯市三级公立医院接受治疗的类鼻疽患者的影像学检查结果：方法：通过数据库搜索和电子病历审查来确定病例。在珀斯公立三级医院进行过至少一次影像学诊断的病例均被纳入研究范围。对相关的影像学检查进行审查，并记录影像学检查结果：结果：共发现 36 例病例。最常见的疾病表现是菌血症（72%，26 例），其次是肺部感染（58%，21 例）、皮肤和软组织感染（22%，8 例）、前列腺脓肿（14%，5 例）和化脓性关节炎（6%，2 例）。此外，还发现了一例以前未报告过的孤立的类鼻疽胸腔积液病例，以及一例重新激活的慢性潜伏肺类鼻疽病例，该病例的症状出现时间与感染时间明显相差 20 多年。在患有肺圆线虫病的病例中，胸部 CT 显示的主要肺部异常可分为两种不同的模式：结节为主（78%）或合并为主（22%）：需要进一步开展研究，以评估本系列病例中肺癌病例胸部 CT 肺部异常的模式分类的实用性。

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引用次数: 0

A multi-centre retrospective study of long-term outcomes of spinal re-irradiation with SABR 一项关于脊柱再放射治疗与 SABR 长期疗效的多中心回顾性研究。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-07-10 DOI: 10.1111/1754-9485.13723

Edward Chmiel, Sashendra Senthi, Shankar Siva, Nicholas Hardcastle, Vanessa Panettieri, Catherine Russell, Mark Tacey, Nigel Anderson, Farshad Foroudi

Introduction

Stereotactic ablative body radiotherapy (SABR) is a highly conformal technique utilising a high dose per fraction commonly employed in the re-treatment of spinal metastases. This study sought to determine the safety and efficacy of re-irradiation with SABR to previously treated spinal metastases.

Methods

This was a retrospective analysis of patients at three Australian centres who have undergone spinal SABR after previous spinal radiotherapy to the same or immediately adjacent vertebral level. Efficacy was determined in terms of rates of local control, while safety was characterised by rates of serious complications.

Results

Thirty-three spinal segments were evaluated from 32 patients. Median follow-up for all patients was 2.6 years, and median overall survival was 4.3 years. Eleven of 33 (33.3%) treated spinal segments had local progression, with a local control rate at 12 months of 71.4% (95% C.I. 55.2%–92.4%). Four patients (16.7%) went on to develop cauda equina or spinal cord compression. Thirteen out of 32 patients (40.6%) experienced acute toxicity, of which 12 were grade 2 or less. Five out of 30 spinal (16.7%) segments with follow-up imaging had a radiation-induced vertebral compression fracture. There was one case of radiation myelitis which occurred in a patient who had mediastinal radiotherapy with a treatment field which overlapped their prior spinal radiation.

Conclusion

The patients in this study experienced long median survival, durable tumour control and high rates of freedom from long-term sequelae of treatment. These results support the use of SABR in patients who progress in the spine despite previous radiotherapy.

简介立体定向消融体放射治疗（SABR）是一种高度适形的技术，利用每分高剂量常用于脊柱转移瘤的再治疗。本研究旨在确定使用 SABR 对之前治疗过的脊柱转移瘤进行再照射的安全性和有效性：这是一项回顾性分析，研究对象是在澳大利亚三个中心接受过脊柱SABR放疗的患者，这些患者曾在同一或邻近椎体水平接受过脊柱放疗。疗效以局部控制率为标准，安全性以严重并发症发生率为标准：对32名患者的33个脊柱节段进行了评估。所有患者的中位随访时间为 2.6 年，中位总生存期为 4.3 年。在接受治疗的33个脊柱节段中，有11个（33.3%）出现局部进展，12个月的局部控制率为71.4%（95% C.I.55.2%-92.4%）。四名患者（16.7%）发展为马尾或脊髓压迫。32 位患者中有 13 位（40.6%）出现急性毒性，其中 12 位为 2 级或 2 级以下。在 30 个有随访影像的脊柱节段中，有 5 个（16.7%）出现了辐射诱发的椎体压缩性骨折。有一例放射性脊髓炎发生在一名接受纵隔放疗的患者身上，其治疗区域与之前的脊柱放疗区域重叠：本研究中的患者中位生存期较长，肿瘤得到了持久控制，长期治疗后无后遗症的比例较高。这些结果支持在脊柱放疗后仍有进展的患者中使用 SABR。

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引用次数: 0

Utility of FDG PET-CT in CT Stage IA non-small cell lung cancer: The New Zealand Te Whatu Ora Northern region experience FDG PET-CT 在 CT 分期 IA 非小细胞肺癌中的应用：新西兰 Te Whatu Ora 北部地区的经验。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-06-28 DOI: 10.1111/1754-9485.13720

Richard J Kelly, Graeme D Anderson, Budresh S Joshi, Jennifer J Donald

Introduction

Our objective was to investigate the utility of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in assessing CT Stage 1A non-small cell lung cancer (NSCLC) in patients under consideration for curative treatment. Performing FDG PET-CT in these patients may lead to unnecessary delays in treatment if it can be shown to provide no added value.

Methods

We retrospectively reviewed 735 lesions in 653 patients from the New Zealand Te Whatu Ora Northern region lung cancer database with suspected or pathologically proven Stage 1A NSCLC on CT scan who also underwent FDG PET-CT imaging. We determined how often FDG PET-CT findings upstaged patients and then compared to pathological staging where available.

Results

FDG PET-CT provided an overall upstaging rate of 9.7%. Category-specific rates were 0% in Tis, 0.9% in T1mi, 7.4% in T1a, 10% in T1b and 12% in T1c groups. The percentage of lesions upstaged on FDG PET-CT that remained Stage 1A was 100% in T1mi, 100% in T1a, 47.1% in T1b and 40.7% in T1c groups. The P value was statistically significant at 0.004, indicating upstaging beyond Stage 1A was dependent on T category.

Conclusion

Our data suggests that FDG PET-CT is indicated for T1b and T1c lesions but is of limited utility in Tis, T1mi and T1a lesions. Adopting a more targeted approach and omitting FDG PET-CT in patients with Tis, T1mi, and T1a lesions may benefit all patients with lung cancer by improving accessibility and treatment timelines.

简介我们的目的是研究氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG PET-CT）在评估考虑接受根治性治疗的 CT 1A 期非小细胞肺癌（NSCLC）患者中的实用性。在这些患者中进行 FDG PET-CT 可能会导致不必要的治疗延误，如果事实证明它没有任何附加价值的话：我们回顾性地检查了新西兰 Te Whatu Ora 北部地区肺癌数据库中 653 名患者的 735 个病灶，这些患者在 CT 扫描中疑似或病理证实为 1A 期 NSCLC，并接受了 FDG PET-CT 成像检查。我们确定了 FDG PET-CT 检查结果对患者进行分期的频率，然后将其与病理分期（如有）进行比较：FDG PET-CT 的总体分期率为 9.7%。Tis组的具体分类率为0%，T1mi组为0.9%，T1a组为7.4%，T1b组为10%，T1c组为12%。FDG PET-CT 上分期病变仍为 1A 期的比例为：T1mi 组 100%、T1a 组 100%、T1b 组 47.1%、T1c 组 40.7%。P值为0.004，具有统计学意义，表明1A期以上的分期取决于T类别：我们的数据表明，FDG PET-CT 适用于 T1b 和 T1c 病变，但对 Tis、T1mi 和 T1a 病变的作用有限。在Tis、T1mi和T1a病变患者中采用更有针对性的方法并省略FDG PET-CT，可能会通过提高可及性和缩短治疗时间而使所有肺癌患者受益。

{"title":"Utility of FDG PET-CT in CT Stage IA non-small cell lung cancer: The New Zealand Te Whatu Ora Northern region experience","authors":"Richard J Kelly, Graeme D Anderson, Budresh S Joshi, Jennifer J Donald","doi":"10.1111/1754-9485.13720","DOIUrl":"10.1111/1754-9485.13720","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Our objective was to investigate the utility of fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in assessing CT Stage 1A non-small cell lung cancer (NSCLC) in patients under consideration for curative treatment. Performing FDG PET-CT in these patients may lead to unnecessary delays in treatment if it can be shown to provide no added value.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively reviewed 735 lesions in 653 patients from the New Zealand Te Whatu Ora Northern region lung cancer database with suspected or pathologically proven Stage 1A NSCLC on CT scan who also underwent FDG PET-CT imaging. We determined how often FDG PET-CT findings upstaged patients and then compared to pathological staging where available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>FDG PET-CT provided an overall upstaging rate of 9.7%. Category-specific rates were 0% in Tis, 0.9% in T1mi, 7.4% in T1a, 10% in T1b and 12% in T1c groups. The percentage of lesions upstaged on FDG PET-CT that remained Stage 1A was 100% in T1mi, 100% in T1a, 47.1% in T1b and 40.7% in T1c groups. The <i>P</i> value was statistically significant at 0.004, indicating upstaging beyond Stage 1A was dependent on T category.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our data suggests that FDG PET-CT is indicated for T1b and T1c lesions but is of limited utility in Tis, T1mi and T1a lesions. Adopting a more targeted approach and omitting FDG PET-CT in patients with Tis, T1mi, and T1a lesions may benefit all patients with lung cancer by improving accessibility and treatment timelines.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16218,"journal":{"name":"Journal of Medical Imaging and Radiation Oncology","volume":"68 6","pages":"645-650"},"PeriodicalIF":2.2,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

MethOxyfluraNe in InTerventiOnal Radiology (MONITOR): A randomised controlled trial 放射学中的甲氧氟沙星（MONITOR）：随机对照试验。

IF 2.2 4区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Medical Imaging and Radiation Oncology

Pub Date : 2024-06-25 DOI: 10.1111/1754-9485.13726

Ross Copping, Paul Balamon, Marcus Lau, Jules Catt, Glen Schlaphoff

Introduction

Procedural sedation and pain management in interventional radiology (IR) are of critical importance to successful outcomes but remain under-researched. Methoxyflurane has been previously used in some minor procedures with several advantages including rapid onset and offset and a good safety profile. The purpose of this study was to evaluate methoxyflurane for procedures in IR.

Methods

A randomised, double-blind, placebo-controlled trial was performed between October 2021 and November 2022. Patients presenting for portacath insertion, portacath removal or solid organ biopsy were randomised to either methoxyflurane or placebo. Three hundred and fourteen patients were enrolled in total. Patients were supplied with one Penthrox inhaler containing either 3 mL methoxyflurane or placebo. The primary endpoints of the study were change in pain and anxiety scores compared with baseline, measured on a standardised visual analogue scale (VAS) pre-procedure, at 5-min intervals during the procedure and post-procedure. Baselines scores were controlled for in the statistical analysis. Safety analysis was also performed.

Results

One hundred and sixty-nine patients received methoxyflurane and 145 received placebo. Baseline characteristics were similar between the two groups. The methoxyflurane group had lower pain and anxiety scores throughout the procedure (P < 0.001) with 2.5 times less pain (VAS 1.08/10) and 1.6 times less anxiety (VAS 0.97/10) on average. Lower post-procedure pain (mean 0.72 vs 1.44; P < 0.001) and anxiety (mean 0.55 vs 1.13; P = 0.008) were also observed with methoxyflurane. There were no drug or major procedure-related adverse events.

Conclusion

The results of this study suggest that methoxyflurane provides safe and effective analgesia and anxiolysis for some procedures in IR.

导言：介入放射学（IR）中的程序镇静和疼痛管理对成功结果至关重要，但研究仍然不足。甲氧基氟烷以前曾用于一些小手术，具有起效快、可抵消、安全性好等优点。本研究的目的是对红外手术中的甲氧基氟烷进行评估：方法：2021 年 10 月至 2022 年 11 月期间进行了一项随机、双盲、安慰剂对照试验。接受门插管插入、门插管移除或实体器官活检的患者被随机分配到甲氧氟烷或安慰剂中。共有 314 名患者入选。患者将获得一个含有 3 毫升甲氧氟醚或安慰剂的 Penthrox 吸入器。研究的主要终点是疼痛和焦虑评分与基线相比的变化，测量方法为术前、术中和术后每隔 5 分钟使用一次标准化视觉模拟量表 (VAS)。统计分析中对基线分数进行了控制。此外，还进行了安全性分析：169 名患者接受了甲氧氟烷治疗，145 名患者接受了安慰剂治疗。两组患者的基线特征相似。在整个手术过程中，甲氧氟烷组的疼痛和焦虑评分较低（P 结论：甲氧氟烷是一种有效的镇痛剂：本研究结果表明，甲氧氟烷可为红外部分手术提供安全有效的镇痛和抗焦虑作用。

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引用次数: 0